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Original Research: LUNG CANCER |

In-hospital Clinical and Economic Consequences of Pulmonary Wedge Resections for Cancer Using Video-Assisted Thoracoscopic Techniques vs Traditional Open ResectionsWedge Resections vs Open Resections: A Retrospective Database Analysis

John A. Howington, MD, FCCP; Candace L. Gunnarsson, EdD; Michael A. Maddaus, MD; Robert J. McKenna, MD; Bryan F. Meyers, MD, FCCP; Daniel Miller, MD; Matthew Moore, MHA; John A. Rizzo, PhD; Scott Swanson, MD
Author and Funding Information

From the Divisions of Thoracic Surgery and Surgical Quality (Dr Howington), NorthShore University Health System, Evanston, IL; S2 Statistical Solutions, Inc (Dr Gunnarsson), Cincinnati, OH; Division of Thoracic Surgery (Dr Maddaus), University of Minnesota, Duluth, MN; Division of Thoracic Surgery (Dr McKenna), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Cardiothoracic Surgery (Dr Meyers), Washington University, St. Louis, MO; Division of Thoracic Surgery (Dr Miller), Emory Clinic, Atlanta, GA; Healthcare Policy and Economics (Mr Moore), Ethicon Endo-Surgery, Inc, Cincinnati, OH; Departments of Preventive Medicine and Economics (Dr Rizzo), Stony Brook University, Stony Brook, NY; and Division of Minimally Invasive Thoracic Surgery (Dr Swanson), Brigham and Women’s Hospital and the Dana Farber Cancer Institute, Boston, MA.

Correspondence to: Candace L. Gunnarsson, EdD, S2 Statistical Solutions, Inc, 11176 Main St, Cincinnati, OH 45241; e-mail:Candaceg@s2stats.com


Funding/support: Funding for this study was provided by Ethicon Endo-Surgery, Inc, Cincinnati, Ohio.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(2):429-435. doi:10.1378/chest.10-3013
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Objective:  The objective of this study was to compare the safety, use, and cost profiles of open thoracotomy vs video-assisted thoracoscopic surgery (VATS) for wedge resection in lung cancer performed by thoracic surgeons in the United States.

Methods:  The Premier database, which contains complete patient billing, hospital cost, and coding histories from > 25 million inpatient discharges and > 175 million hospital outpatient visits, was used for this analysis. Eligible patients were those who underwent wedge resection by a thoracic surgeon for cancer diagnosis or treatment through open thoracotomy or VATS in 2007 or 2008. Multivariable logistic regression analyses were run for binary outcomes, and ordinary least squares regressions were used for continuous outcomes. All models were adjusted for patient demographics, comorbid conditions, and hospital characteristics.

Results:  Of 8,228 eligible procedures, 2,051 patients underwent wedge resections by a thoracic surgeon using the open technique (n = 999) or VATS (n = 1,052). Hospital costs remained significantly higher for open wedge resections than for VATS ($17,377 vs $14,795, P = .000). Surgery time was significantly longer for open resections vs VATS (3.16 vs 2.82 h). Length of stay was 6.34 days for open vs 4.44 days for VATS. Adverse events were significant in the multivariable analysis, with an OR of 1.57 (95% CI, 1.29-1.91) in favor of VATS.

Conclusions:  Although this retrospective database analysis could not address the issue of oncologic outcome equivalence, a clear advantage of VATS over open wedge lung cancer resection was found for both acute clinical outcomes and hospital costs.

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